Provider Demographics
NPI:1992138002
Name:LORENZ, ZACK LUCAS (BA)
Entity type:Individual
Prefix:
First Name:ZACK
Middle Name:LUCAS
Last Name:LORENZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1223 EL PRADO AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2708
Mailing Address - Country:US
Mailing Address - Phone:310-320-5856
Mailing Address - Fax:310-787-1768
Practice Address - Street 1:1223 EL PRADO AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2708
Practice Address - Country:US
Practice Address - Phone:310-320-5856
Practice Address - Fax:310-787-1768
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0-13-5512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0-13-5512OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC.